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PT V M De Jong, CC W Klaver, R van Leeuwen, HR Vingerling; An International Classification system for Incident Age-related Maculopathy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4395.
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Background: An international classification system for grading of fundus signs of ARM was developed in 1995 and has proven to be effective for comparing data among studies. In order to keep comparability in incidence studies and treatment trials, and to have sufficient power for risk factor analyses for incident age-related maculopathy (ARM) there is a need for a simple classification system that makes stratification of fundus signs and stages of incident ARM possible.Purpose: To propose an international classification system for incident ARM based on predictive power of baseline ARM stages for incidence of late ARM, that is similar to age-related macular degeneration (AMD). Method: Fundus color transparencies of subjects from baseline and follow up exams from the Rotterdam Study were graded according to the International Classification system for prevalent ARM. Incidence rates for AMD were calculated for each group of fundus changes at baseline. ARM fundus signs were stratified in groups based on comparability of fundus abnormalities and incidence rates. Incident ARM was defined as the absence of a sign specific for a stage of ARM within the fundus grid area in either eye at baseline and the presence of a lesion in a higher class in at least one eye at follow up. Results: Incident ARM thus was divided in five classes: No ARM: Class 0: hard drusen ≤ 63:m Early ARM Class 1: Soft distinct drusen or pigmentary changes Class 2: Soft distinct drusen with pigmentary changes or Soft indistinct or reticular drusen without pigmentary changes Class 3: Soft indistinct or reticular drusen with pigmentary changes Late ARM Class 4: Geographic atrophy or neovascular AMD. Conclusion: Although adjustments for extent of lesions or functional implications may be indicated, this scheme is proposed in order to spur discussion on a good new classification system.
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